Abstract

Interventions designed to influence people's behaviour ('behavioural interventions') are a fundamental part of daily life, whether in the form of personal advice, support and skills training from professionals (e.g. educators, doctors) or general information disseminated through the media. However, personal advice and support are very costly, and it is impossible to provide everyone with 24-hour access to personal guidance on managing all their problems. General information provided through the media may not be seen as relevant to the particular problems of individuals, and provides no support to help people make desired changes to their behaviour. For the first time, the World Wide Web provides a cost-effective opportunity to provide open 24-hour access to extensive information and advice on any problem. Interactive technology means that the advice can now be specifically 'tailored' to address the particular situation, concerns, beliefs and preferences of each individual, and intensive daily support can be provided for behaviour change in the form of reminders, personalised feedback regarding progress and overcoming obstacles, help with planning, and opportunities for communication with peers. In view of this huge potential, web-based behavioural interventions are starting to be developed in the public and private sector. However, currently each intervention is individually programmed from scratch, with the result that the initial development costs are greater for web-based than for traditionally delivered interventions, and once programmed they cannot easily be modified. This seriously limits the number of interventions that can be developed and evaluated, and acts as a barrier to innovation and enhancement of interventions by researchers. The aim of the LifeGuide project is to develop, evaluate and disseminate a set of tools that will allow researchers to flexibly create and modify two fundamental dimensions of behavioural interventions: providing tailored advice; and supporting sustained behaviour. The LifeGuide toolkit will eliminate the costly waste of resources involved in programming every intervention individually, and will allow researchers to easily test components of interventions and immediately modify and improve the interventions based on their findings. The tools will also increase the number of researchers who can engage in this type of research, opening it up to those with limited funding (e.g. junior researchers and research students). The practical benefit will be more rapid development of better interventions, while the scientific benefit will be a much faster accumulation of knowledge about the effects of different elements of interventions than at present, which will improve our basic understanding of the influences on behaviour. In the project, social scientists and computer scientists are working closely together to develop the software needed, using extensive expert consultation through workshops and the internet to obtain researchers' views of how to make the software fit for all requirements. The LifeGuide software essentially comprises of three main components: a web-based player through which end user can access an intervention; a web-based management interface through which researchers can control and view data from their interventions; and a standalone desktop-based authoring tool in which researchers can create and edit interventions. The tools also enable the construction of randomised controlled trials (RCTs) for the interventions. The LifeGuide player component is in essence a generic adaptive hypertext system, augmented with the ability to record specialised usage and timing information. From perspective of the end user, a web-based intervention is accessed through a browser and appears as a series of web pages with questions and tailored advice. Rather than starting from scratch in developing a framework for defining interventions, we have adopted the use of a leading e-learning specification, IMS Question and Test Interoperability (QTI). The QTI specification describes a data model for representing electronic assessments, consisting of items (pages with questions), tests (the flow between the pages) and the reporting of results. This is particularly suited to modelling an intervention, as a behavioural intervention can itself be seen as a form of assessment. QTI items can consist of multiple questions or interactions with different forms (e.g. text entry, multiple choice, numeric sliders, etc). QTI also defines a model for adaptive assessment in which the current location within an assessment can be defined as a series of pre-requisite conditions or branches. These conditions are defined through a simple, but flexible, programming language that allows the evaluation of arbitrarily complex expressions that are capable of examining previous responses from the user. The QTI specification has a complete binding to XML, which means an intervention can be represented as a series of XML files. QTI items can be rendered as XHTML in a web browser by simply transforming them using XSLT. The LifeGuide player software incorporates many extensions to the QTI specification using the pre-defined extension points, in order to add additional functionality. For example, we have provided the ability for interventions to be able to automatically send emails to registered users at given times if certain conditions are met. The LifeGuide manager software allows researchers to manage and query existing interventions. For example, the software is capable of showing how many people used a particular intervention in a given time period, and how the users were geographically located. It is also possible for researchers to drill down to the level of a particular user of an intervention and view data, such as the QTI report, and information about the ordering of pages viewed by the user. The QTI report data includes information about the users’ responses to questions and how long the user spent on particular parts of the intervention. The manager software will also be capable of generating and exporting reports from the recorded data over groups of many users or sessions for further analysis in external software. The LifeGuide authoring tool enables researchers to create new interventions. In particular, the pages (instances of QTI items) are created in a graphical WYSIWYG editor that displays the pages exactly as they will appear in the users web-browser. The logic that determines the adaptive features of the intervention is expressed in a simple programming language inspired by xTalk family of languages. Currently in the project, we have completed the construction of the player software, and the first release of the manager component has been deployed. The first intervention developed for the LifeGuide platform, a health intervention designed to advise users on dealing with cold and flu symptoms, has been released for user acceptance testing and qualitative piloting. Quantitative piloting of the intervention, using all of the data recording facilities of the player software and reporting facilities of the manager software is scheduled to take place early in the New Year. In the longer term, we intend to investigate how the LifeGuide toolset can be applied to domains other than behavioural interventions. In particular, we intend to investigate the use of the tools in the e-assessment/e-learning domain. Another possible use for the tools is for developing online questionnaires that require adaptivity or wider varieties of interaction than current tools can provide. With respect to behavioural interventions, one future aim is to further develop the LifeGuide tools into supporting a “population laboratory” which will enable the quantitative results from multiple interventions to be shared and analysed together.